Wednesday, May 27, 2015

The Illinois Medicaid Redetermination Project (IMRP) is erroneously suspending vital medical care for people who remain eligible. Since the rollout of the IMRP in early 2013, the program has been plagued by inadequate communication from the state that leaves consumers confused and ultimately without healthcare. Consumers report that they are not receiving the required notices by mail and when they call with questions, frontline state staff cannot provide answers. Because of the state’s ineffective communication protocols and inadequate employee training, rightful Medicaid beneficiaries are in the precarious situation of being unable to fill their prescriptions, go to the doctor or receive treatment. The purpose of the IMRP is to save state dollars by trimming the Medicaid program of those who are no longer eligible, not cut people who still deserve services.

Letters Lost in the Mail

Medicaid beneficiaries are cut simply because they never received their redetermination notices in the mail. For example, Health & Disability Advocates worked with a mother whose child had been dropped from Medicaid because IMRP sent the notice to a non-existent address. The fact that IRMP sent the letter to an incorrect address on the same street where the family lived suggests that it was a clerical error. In this situation, a young adult dealing with serious mental illness could not access medication and treatment, because the state, not the individual made an error. Sudden lapses in care can pose serious consequences for people who rely on these supports for their physical and mental health.

This is not an isolated instance. A survey of case managers working with older adults and people with disabilities found that the IMRP fails to adequately notify people of their redetermination responsibilities and inform them when they are bounced from the program. Many get the bad news when they attempt to fill prescription or go to the doctor and are told that they are no longer covered. People deserve clear communication from the state telling them they are no longer covered and the steps to get reinstated.

Confused and Not Covered

Even in cases where Medicaid recipients do receive notices, many consumers find the letters are hard to understand and filled with jargon. Given that the intended audience has never before been required to submit to annual redeterminations and may also have lower literacy levels, the letters must be crystal clear. Reports from case managers suggest the letters are confusing. One case manager surveyed noted “clients do not understand what documents they need to submit with the form and whether they need to submit anything.” With the potential for people to lose their health coverage, the consequences of this confusion are severe.

IMRP’s own data reveal their communication shortcomings. According to May’s Medicaid redetermination numbers, 81% of cancellations are due to a lack of response. Being cancelled doesn’t mean a person is ineligible. In fact, a substantial portion of these clients should still be receiving services. Of those dropped, 1/3 were reinstated within three months. In FY 2015 alone, this translates into 238,025 people being incorrectly cut from Medicaid, and this number could be even higher. People who are less frequent healthcare users may learn of their cancellation when they attempt to schedule a doctor’s appointment. With people who deserve Medicaid cut from the program, the IMRP is not achieving its main objective of reducing state expenditures by eliminating those who no longer qualify. Cutting eligible people will actually result in higher costs. Without access to primary medical treatment, people will resort to more costly emergency room care for conditions that could have been managed or even prevented.

Matters get worse when consumers call state workers for clarification, because frontline staff members are often not fully informed themselves. In the above-mentioned case of the mother fighting for her son’s coverage to be reinstated, her interaction with the IMRP hotline was unhelpful and hurtful. The representative said there was nothing more she could do and blamed the family. Stateline workers should be fully trained to provide answers; anything less only increases confusion and frustration.

The Path Forward

The state must develop plain-language notices that explain redeterminations and their importance while outlining the specific steps to keeping coverage. This would not be a new undertaking. State officials have previously brainstormed ways to create simple, more consumer friendly forms. Unfortunately, the furor around budget deficits and service cut threats has drowned out the push for clear communication standards. Even worse, continuing to deemphasize this issue will leave many rightful Medicaid recipients suddenly without coverage. Communication protocols and state staff should support individuals in maintaining their vital connection to healthcare, not create hurdles that effectively jeopardize emotional and physical health. State officials must restart the discussions on clear notices and broaden the conversation to include improved training for frontline staff. These reforms will go a long way towards supporting the IMRP’s original objective of eliminating wasteful spending while also keeping those who still deserve coverage connected to care.

Friday, May 8, 2015

The Affordable Care Act brought about the expansion of Erie Family Health Center, the only health clinic in Evanston and Skokie. Long after its opening in Evanston, Erie Family Health Center was under capacity and wanted to reach more people. In contrast, the Evanston and Skokie Health Departments conducted community surveys in 2013 and found that one of the most prevalent health issues identified by the community was access to healthcare.

Something needed to change in the way that people accessed the healthcare system and the way they were connected to information and care. Inequalities in the healthcare system limit the types of care and information for people of different backgrounds. Many people do not know how to access quality health information or where to go for their health-related needs.

A Community Collaboration Promoting Health

Students at Northwestern University are partnering with public institutions, community organizations and university departments to create student-run health resource centers at the Evanston and Skokie libraries. Called the Health Information Resource Centers Utilizing Libraries in Evanston and Skokie (HIRCULES) Health Hub, the initiative will work to promote health literacy, preventative care, awareness of community resources and understanding of the existing healthcare system. The program is powerful and unique; it empowers people to take ownership through guidance, linkage and education.

The HIRCULES Health Hub will provide the Evanston and Skokie community with a trusted central resource where they can be connected to educational materials to improve health literacy. The HIRCULES Health Hub desks will be staffed by Northwestern students trained as medical librarians at Evanston and Skokie Public Libraries. Students will gather resources and search for materials for library patrons. HIRCULES will also include a website with relevant health resources and databases that contain searchable information including frequently asked questions, health services available in Evanston and Skokie and a calendar of health-related community events.

Identifying Challenges, Creating Solutions

The HIRCULES Health Hub will feature monthly themes with digestible and accessible information. Developing these monthly themes has taught staff a great deal about the community and led to new solutions. For example, last summer staff created a Back to School theme and wanted to inform parents where they could obtain school supplies if they could not afford to buy them from a store. The organization that had previously provided this service had recently closed, and with two months until the start of the new school year, no one else was planning to provide supplies to any Evanston school districts. HIRCULES staff reached out to community organizations, Parent Teacher Associations and school district boards to find a point person who ran a program to fill the need for school supplies for low-income students. Because of HIRCULES, real needs of the community were identified and addressed.

Improving Knowledge and Health

Normalizing routine, preventative care is another important aspect of the project. HIRCULES staff will promote preventative care through education of how to utilize Federally Qualified Health Centers and medical homes. Most people are not aware of the implications of the Affordable Care Act, which promotes preventative care. This reduces costs and improves health outcomes over time. Emphasis on preventative care education is imperative in empowering people to utilize pre-acute and ambulatory points of access to health systems. The partnership between HIRCULES and Erie Family Health Center helps establish a healthy lifestyle through regular, preventative primary care checkups and referrals for more complex health services.

Information Hub for the Community

The final objective of HIRCULES is to guide people to health-related resources, simplifying their search for health and wellness and improving services in the existing, complex healthcare system. All available, health-related resources in the community are being compiled into a virtual database accessible online and through visiting the HIRCULES Health Hub. For example, if an expecting mother wants to know where she can access prenatal and postnatal care, HIRCULES staff can direct them to Family Focus. If a parent needs assistance enrolling his or her family in health insurance, they will be connected with a local health insurance navigator and resources from Get Covered Illinois.

These major health issues will take time to address and overcome. Programs like HIRCULES are a vital contribution to making positive changes and improving the health of Evanston and Skokie citizens.

Brittany Zelch & Emery Weinstein

Brittany and Emery are undergraduate students attending Northwestern University Weinberg College of Arts and Sciences who study global health. They helped found and remain involved in the HIRCULES Health Hub.